Why must only the poor suffer?

In Barwani, Madhya Pradesh, people lost their sight after botched up cataract surgeries. Was it because the organizers, the medical and paramedical staff of the district hospital did not take necessary steps? Or was the quality of medication used questionable? Or, because the victims are too marginalised and too poor to protest? Asks Shoma Chatterji.

This is the story of a group of 86 people who underwent cataract surgery in a camp which was jointly organized by Barwani district hospital and the Lion’s Club. These surgeries took place between 16 and 24 November, 2015, under the District Blindness Control Programme (DBCS), which implements the central government sponsored National Blindness Control Programme at the state level.

A committee was formed under the DBCS chaired by the District Collector. This committee allocates budget to NGOs for the camp and procures drugs, injections, and other necessary items through state level tender, or local tender or direct purchase under the guidelines set by the government.

A total of 86 patients from Sendhwa, Silawad, Dhanora, Warla, Chachria, Balwadi, Pansemal, Niwali, Piplaj, Ekkalwara, Kashta, and Dharamrai of Barwani and Dhar district of Madhya Pradesh were operated upon in the camp.

Of these 86 patients, 66 patients have lost sight in one eye completely. The condition of the remaining 20 patients has not been made public. But according to Amulya Nidhi a social worker who is a member of an independent investigating team, it now transpires that all the patients have lost their vision after the surgery.

The victims of the botched cataract surgery performed at the district hospital of Barwani with their family members. Pic: The independent investigating team

Most of the victims are old and very poor and loss of vision can lead to loss of health, and more importantly, loss of their livelihood. Since the 86 patients did not undergo cataract surgery simultaneously, one gets to understand that subsequent surgeries were not stopped even when complaints of serious post-operative complications became known within a couple of days of the surgery of the first batch of patients. Why?

The independent investigation and report

An independent investigation was carried out by the representatives of Jan Swasthya Abhiyan (JSA), Narmada Bachao Andolan (NBA) and Swasthya Adhikar Manch (SAM) to look into this fiasco. The members of the investigative team are - Rakesh Chandore, Dhara, Amulya Nidhi, S.R Azad of JSA, Medha Patkar, Devisingh Tomar, Bhagirath Dhangar and Rahul Yadav of NBA and Chinmay Mishra of SAM.

Rakesh Chandore, a leading member of the team says, “The State government has taken cognizance but, very few steps have been taken up by government like suspension of the surgeon and some assistants, some drugs and fluids are taken for test but government have to do more in this matter, specially in the matter of drug procurement. According to the doctors of AIMS who refused to be named, one of the main reasons for this serious tragedy is the use of sub-standard drugs.”

The independent investigation team came out with a report that mentions several lapses in the procedure and practice followed in the eye surgeries:

(a) the equipment used during and for the surgery led to infections to occur and spread over time;

(b) surgeries were done in unhygienic conditions not conducive to surgery;

(c) there was serious lack in follow-up by doctors and medical team in the hospitals such as centralized and timely check-up in the district hospital;

(d) identification and timely treatment of infection was not done;

(e) a completely casual approach that reveals the criminal neglect by eye surgeons and supporting staff including the Chief Medical Health Officer led to more operations in the same patients without having acted on the first compliant though the first batch had come back with various complaints and infections.

And cases like:

Rashid Khan, a patient who lost his sight after the cataract surgery in Barwani. Pic: The independent investigating team

Rashid Khan came to the district hospital of Barwani on 14 November, 2015 for the treatment of one of his eyes. On the same day at 6 pm, he underwent cataract operation. He was discharged on 15 November, 2015 from the hospital. Around 8 days later, he complained of severe discomfort in his eye. He came back to the hospital on 24 November and was sent back home after treatment. However, he got no relief. He went to Dr. Malviya of Saraswati Hospital on 28 Nov and spent Rs 200 on fees and Rs 1400 on medicines. His bills are available. He got no respite from the pain and itching in his eye. He was sent to Sri Aurobindo Institute of Medical Science (SAIMS) Indore on 3 December, 2015. Rashid Khan has now lost vision in his eye.

Nania, son of Junga, from Village Kashta, Dharamrai, Nisarpur Block, Dhar went to the house of eye specialist Dr Radhesham Palod on 18 Nov, 2015 for treatment of one of his eyes. He paid the doctor Rs 200 fees and Rs 2500 for the cataract surgery, which was carried out free of cost the next day at the eye camp in the District Hospital. Nania was discharged the next day following the surgery. He began to suffer pain and burning in his eye. He came back to the district hospital on 28 November and saw Dr. Malviya on 29 November. His symptoms did not change at all and he got no relief. He was sent to SAIMS and yet lost sight of his eye.

Nania, another patient who paid money and yet lost his sight after the cataract surgery in Barwani. Pic: The independent investigating team

It may be noted that the surgeries and doctor’s services are free of cost yet Rashid and Nania paid the doctors. And these are just two out of the 86 cases. Dr. Palod is the one under whose guidance the cataract surgery camp was organised and executed.

After the operations, at the time of discharge, the patients were advised to visit their nearest health centre for follow-up. Based on findings and interviews with patients and their relatives, it was learnt that the patients were prescribed Moxicip Eye Drops (Moxifloxacin), batch number C850127 of Cipla, Zoxan D of FDC Ltd, Atropine Sulphate of Jawa Pharmacy, Biotin, Levofloxacin and Ibuprofen at the time of discharge. The question around where these medicines were sourced from – centrally from Bhopal or locally from Barwani is not known.

On the second and third day after the surgery, the patients went to health centers/or to their district hospital with complaints of burning sensation and pain in the eyes. They were given injections and some medicines and were asked to return for follow-up. Some patients went to private hospitals and spent from their pockets for follow-ups as the district hospital was far. The patients got no relief from their symptoms.

By 18 and 19 December, similar multiple complaints of pain, itching and watering eyes had started pouring in from the first batch of patients; despite that, surgeries of new patients continued. It is beyond comprehension as to why fresh surgeries were continued even after knowing that things were amiss and earlier patients had caught severe infections.

When the complaints became acute and widespread, most patients were asked to come to the district hospital where they were admitted for follow-up treatment. But none of the patients got any relief from this treatment. Some of the patients were taken to a private hospital namely to Dr. Rajendra Malviya of Saraswati Eye Hospital.

As per the interviews conducted by the independent team with the patients, it came to light that the letterhead portion of the prescription of Dr. Malviya was torn off and the rest of the prescription was filed in the hospital file! How could this happen or be allowed to happen? The investigators are in possession of sample copies of Dr. Malviya’s prescriptions.

When the patients found that they got no relief at all, they were referred to SAIMS Indore. Some were referred to Maharaja Yashwantrao Hospital (MYH) Indore were they were kept for a day and then moved to SAIMS. The investigators wonder why the patients were not treated at MYH, which is attached to Mahatama Gandhi Memorial Medical College and had adequate number of ophthalmologist specialists at all levels to take care of the crisis situation.

SAIMS is a private hospital which was at the center of a controversy three years ago. Who sent these patients from MYH to SAIMS remains a mystery. Much less, why? No one knows if this shift from MYH to SAIMS cured the patients of their loss of sight.

There is another niggling question. The first referral to Indore occurred on 3 December, 2015 whereas infections were reported by 18-19 November, 2015 time frame. What caused this terrible delay when it was a question of the sight of so many people even after infections were confirmed?

The government response

The state government on its part has set up its own three-member investigative team to probe into the matter. But it has failed or deliberately not disclosed batch numbers, quality test reports, company names and procurement detail of drugs, injections and fluids used before the surgeries and after.

The independent investigating team from JSA, NBA and SAM insists that the government’s team must immediately make public the names of companies from where the drugs were procured, the beneficiaries of these companies and/or people who stand to benefit financially from these companies. “The question of supplying sub-standard drugs throughout the state had been raised earlier too but the government had paid a deaf ear to this,” says one of the members of the independent investigation team.

The state government has suspended Dr Palod and initiated action against the authorities of the Lions Club. The operation theater where the surgeries were conducted has also been sealed. Dr. Amar Singh Vishnar, the District Civil Surgeon was also suspended along with five others.

Treating surgeon at SAIMS, Dr Nitin Neema said, "Patients were admitted to hospital immediately two or three days after the operations at the Barwani camp. We have submitted patient-wise details to health department authorities. Few patients are critical. There are causes of infection source but it will be premature to comment on source."

Dr Preeti Rawat, a treating doctor at MYH said, "Of three patients, one was discharged and other two are critical. Infection could have been a result of improper sterilization of equipment or due to patient's negligence in following pre and post-operative measures."

On December 7, the CM said that his government is very concerned and would take strict action against those responsible for the botched up cataract surgery camp. He added that the state government has ensured that the victims will get full medical care and all the medical expenses of the victims will be borne by the government.

The state government is providing two lakh rupees to all the victims' family and a pension of Rs 5000/month to the victims. So far cheques have been given to 12 victims of the camp who lost their vision. But most of them are unable to use the cheque right away because of technical gaffes such as wrong name or wrong spelling of the name given in the cheque.

Joint director (health) Dr Sharad Pandit said, "I have taken stock of the situation. There are some cases of severe eye infection. We have launched a probe into the matter. Senior officials will find the root cause for lapse. Appropriate action will be taken if lapses are found on part of the health department staff. I have also sought a report from Barwani chief medical and health officer. The surgeries were performed by Dr Radheshyam Palod."

The fiasco continues

A new discovery made by the investigating team is that among the victims who lost their vision following the surgery is a 13-year old boy who had come to the eye camp for treatment of his vision that had been disturbed by an injury to his eye. According to the guidelines of the National Blindness Control Programme, no child should be taken to an eye camp for surgery because the hospital situation does not have the infrastructural necessities to take care of children of disturbed vision. The team has placed a complaint to theNational Commission for Protection of Child Rights (NCPCR) about this serious anomaly and demanded a detailed and complete investigation into the matter. The team insists that a child being operated upon for an eye injury in an eye camp for adults violates not only the National Blindness Control Programme regulations but also the rights of a child.

The Barwani Eye Camp fiasco is unfolding a new scam every passing day. The investigating team states that instead of taking prompt steps to look into this grave violation of human rights and create the necessary tools to rectify all this, the state government is trying to suppress the matter. The team demands a neutral and objective investigation into the matter by the necessary offices of the State Government.

The investigating team states that the government not only did not accept the claims stated in the report submitted by it on this fiasco but also did not take any steps to discuss remedial measures with the team. The team therefore concludes that the state government has probably decided on its procedural strategies beforehand and is not interested in discussing the reality of the situation on the basis of the report.

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Amitabha Basu

Retired Scientist

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